Hello, I am 21 years old. Around July–August last summer, I went through very severe stress. I was sleeping only about 3 hours a day and couldn’t eat properly. I started losing hair from everywhere, including the back of my scalp. Later I recovered my sleep, and in November I went to a doctor and had 4 PRP and mesotherapy sessions, but they didn’t help. Then I was prescribed a topical finasteride + minoxidil solution, but it was very expensive and inconvenient, so I used it for only 1 month and stopped.
Immediately after that, I started dutasteride on my own (0.5 mg, 3 times per week). As soon as I started, I experienced very heavy shedding. Before starting dutasteride, I had done two buzz cuts. I also noticed weaker erections, so I reduced the dose to twice per week. Now I have been using dutasteride for 2 months and 2 weeks. The shedding has stopped a bit, but the hairs that fell out were about 1 cm long, thick at the tip and clearly thinner toward the root. It feels like the thinning became more aggressive after starting dutasteride, because even though I had shedding before, I had never seen thinning progress this fast. My scalp has also become itchier and I have more pimples.
One month after starting dutasteride, my blood test showed SHBG 18.83 nmol/L (near the lower limit) and DHEA-S 565 (near the upper limit). I went to another doctor, but he didn’t listen carefully and told me to switch to finasteride 1 mg, 5 times per week.
Should I stop dutasteride or switch to finasteride? I also read about reflex hyperandrogenicity while researching. Could my situation be related to that?
(My English wasn’t good enough to write these, so I got help from AI.)
very rare but possible. you should discuss this with a qualified doctor. 1mg finasteride is still a potent choice. topical finasteride and minoxidil runs me for about 300-400tl per month for 240ml. Not sure how it is “very expensive”. Keep in mind I have the lab-grade tools, raw materials and equipment to make my own batch but anyways. They should not be like 2000-3000 turkish liras. I got it done to a compounding pharmacy a few months ago and it was 400tl for 100ml, far expensive compared to mine yes but still cheap, assuming you pay 800tl per 1 month for 200ml. They are really scamming you if they charge you 2000-3000 TL.
Shedding on dutasteride is not heard of. However this detail is strange, like very strange. It may suggest that dutasteride is not working in the way it should to me, but I am not a doctor so keep that in mind.
However, you mention that you were losing hair from the back of scalp. Norwood-Hamilton classification does not incorporate the rearmost regions of the occupital scalp, only some thinning can occur there and that is in the advanced stages of the androgenetic alopecia.
To me it sounds like you suffer from something akin to telogen effluvium because you don’t really mention “balding” in the classical sense. Dutasteride is not well-studied for the treatment of telogen effluvium and I don’t think it would really help. Before prescribing any anti-hair loss medicine the doctors SHOULD perform a trichoscopy ideally. Because there is no other way to be 100% sure that it is male-pattern baldness. But telogen effluvium works through cycles, so this does not hold ground too if the hair strands are thinner to the bulb?
The miniaturization of hair follicles in the context of male pattern baldness ALSO typically occur over a course of hair cycles and not in one cycle. I am honestly stuck 
. The whole thing doesn’t make sense, like at all. DHT doesn’t cause immediate telogen release (the scientific term for drug-induced shedding). I don’t think any normal doctor would understand you, if I were to give you 1 advice it would be to find a very, very good doctor. I am in this hair loss industry for some time and if I cannot understand it properly I doubt anybody else would man. Screw those compounded overpriced topical min+fins. Dude, please go see the best doctor you can find.
Only thing I would say is go find the best doctor you could and explain it to him/her in as much detail as possible.
Also 100ml of 0.1% finasteride will run me for about 100tl with transportation/shipment fees for me. I can source raw material from the pharmaceutical firms. So keep that in like mind. If you add %5 minoxidil it would be about 100-200tl, if I source minoxidil from a chemical firm instead of a pharmaceutical firm/depot which I don’t recommend though. This is nothing for Turkey, people pay way more for useless stuff. I would speculate that minoxidil sourced from a pharma firm would cost somewhat more but likely still inside the 100-200tl range imho. You are getting scammed, I am afraid if you complain of how expensive it really is. 100ml will last you 1 month roughly with 3ml application each day plus compensating for loss. you can apply minoxidil once every day to my knowledge (tho twice is better for optimal results).
This text is not a medical advice